title: Acute phase proteins for the diagnosis of bacterial infection and prediction of mortality in acute complications of cirrhosis.
abstract: BACKGROUND
  Bacterial infection is a frequent complication in patients with decompensated liver cirrhosis and is related to high mortality rates during follow-up of these individuals. We sought to evaluate the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosing infection and to investigate the relationship between these biomarkers and mortality after hospital admission.
  
  
  METHODS
  Prospective study that included cirrhotic patients admitted to the hospital due to complications of the disease. The diagnostic accuracy of CRP and PCT for the diagnosis of infection was evaluated by estimating the sensitivity and specificity and by measuring the area under the receiver operating characteristics curve (AUROC).
  
  
  RESULTS
  A total of 64 patients and 81 hospitalizations were analyzed during the study. The mean age was 54.31 ± 11.87 years with male predominance (68.8%). Significantly higher median CRP and PCT levels were observed among infected patients (P < 0.001). The AUROC of CRP and PCT for the diagnosis of infection were 0.835 ± 0.052 and 0.860 ± 0.047, respectively (P = 0.273). CRP levels > 29.5 exhibited sensitivity of 82% and specificity of 81% for the diagnosis of bacterial infection. Similarly, PCT levels > 1.10 showed sensitivity of 67% and specificity of 90%. Significantly higher levels of CRP (P = 0.026) and PCT (P = 0.001) were observed among those who died within three months after admission.
  
  
  CONCLUSIONS
  CRP and PCT were reliable markers of bacterial infection in subjects admitted due to complications of liver cirrhosis and higher levels of these tests are related to short-term mortality in those patients.
authors.affiliation: Division of Gastroenterology, Federal University of Santa Catarina, Brasil. cesarlazzarotto@ig.com.br
authors.forename: César
authors.initials: C
authors.lastname: Lazzarotto
authors.forename: Marcelo Fernando
authors.initials: MF
authors.lastname: Ronsoni
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fayad
authors.forename: Christiane Lourenço
authors.initials: CL
authors.lastname: Nogueira
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Bazzo
authors.forename: Janaína Luz
authors.initials: JL
authors.lastname: Narciso-Schiavon
authors.forename: Leonardo
authors.initials: L
authors.lastname: de Lucca Schiavon
authors.forename: Esther Buzaglo
authors.initials: EB
authors.lastname: Dantas-Corrêa
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide